Minor burns and wounds

Definition of acute wound

Wound that tends to heal within 1 month of proper care

Definition of chronic wound

Wound that does not heal properly and shows no progress towards healing in 30 days

Local factors associated with delayed or poor wound healing

- Inadequate tissue perfusion and oxygenation

- Inadequate moisture

- Presence of foreign bodies, necrotic tissue, or infection

Systemic factors associated with delayed or poor wound healing

- Advanced age (over 6)

- Stress

- Inadequate nutrition

- Conditions such as diabetes and obesity

- Immunocompromising conditions

- Alcoholism, smoking, certain meds

3 phases of wound healing

- Inflammatory

- Proliferative

- Maturation (remodeling)

Most common bacteria that cause minor wound infections

- Staphylococcus aureus

- Pseudomonas aeruginosa

- Streptococcus species

What vitamins are often used in wound treatment and what is their effect?

Vitamins D and E for scar treatment

When should you reassess burns?

24-48 hours since changes can happen during this time

Where should you refer a patient who is excluded from self-treatment for a burn?

Emergency department

What should you do if the burn is worse after 24-48 hours of treatment?

Refer to HCP

How long can you self-treat burns or wounds?

7 days

What are the benefits of a moist environment for wound healing?

It stimulates cell proliferation and encourages epithelial cells to migrate to heal the wound

Where should you refer a patient who is excluded from self-treatment for a wound?

PCP or ER

Purpose of surgical tape

Hold gauze in place

Which wound dressings do not require surgical tape?

Newer adhesive gauze porducts

What is the preferred choice for wound irrigation?

Clean tap water

Definition of thermal burn

Results from skin contact with flames, scalding liquids, hot objects, or inhalation of smoke or hot vapors

Definition of electrical burn

Electricity flows through the body from an entry point to an exit point, and the heat of the electric current damages the skin

Definition of chemical burn

- Secondary to exposure to corrosive or reactive chemicals that cause tissue damage, ulceration, and sloughing

- Necrotic tissue may serve as a reservoir of the harmful chemical

What should you do with clothing exposed to chemicals?

Remove clothing if not adherent to the skin to prevent contamination

How long should you rinse affected area of a chemical burn?

At least 15 minutes ap water (do not delay person from going to ER)

What to do if someone gets a chemical burn in the eye

Contact poison control center immediately and pull back eyelid and rinse with tap water for at least 15-30 minutes (nasal side to outside corner)

Definition of sunburn

- Too much exposure to ultraviolet A and ultraviolet B light in natural sunlight and from use of tanning beds and lamps

Definition of UVA

95% of radiation that reaches surface of earth, penetrates skin deeper, responsible for tanning, photoaging, skin cancer, etc.

Definition of UVB

Responsible for erythema as well as tanning/photoaging (but less than UVA)

Definition of abrasion

Rubbing or friction that affects the epidermal layer of the skin, extending to the uppermost portion of the dermis

Definition of puncture

Piercing of the epidermis by a sharp-pointed object and may reach into the dermis or deeper tissues

Definition of laceration

Cutting through the various layers of the skin by a sharp-edged object

Description of inflammatory stage of wound healing

- Body's immediate response to injury

- Responsible for preparing the wound for subsequent tissue development

How long does the inflammatory stage of wound healing last?

About 3-4 days

Description of proliferative stage of wound healing

- Wound is filled with new connective tissue and covered with new epithelium

How long does the proliferative stages of wound healing last?

About 3 weeks

Description of maturation stage of wound healing

- Continual process of collagen synthesis and breakdown, with replacement of earlier-constituted, weak collagen by high-tensile-strength collagen

How long does maturation stage of wound healing last?

Peaks about 60 days after injury

Treatment goals of minor burns and wounds

- Relieve symptoms

- Promote healing by protecting the burn or wound from infection and further trauma

- Minimize scarring

Description of stage 1 wound

Nonblanchable erythema of intact skin with warmth and redness

Examples of stage 1 wounds

- Minor sunburn and superficial burns

Time for stage 1 wound to heal

3-7 days

Pain level of stage 1 wound

Pain

Self-treat or refer for stage 1 wound

Self-treat

Description of stage II wound

- Superficial lesions with partial-thickness skin loss involving the epidermis with or without extension into the dermis

- May have drainage from blister

Examples of stage II wound

- Severe sunburn, abrasion, superficial lacerations and punctures, superficial partial-thickness burns, and deep partial-thickness burns

Time to heal for superficial partial thickness stage II wounds

2-3 weeks with minimal or no scarring

Time to heal for deep partial-thickness stage II wounds

Up to 6 weeks with potential of scarring

Pain level of stage II wounds

Maybe more severe pain

Self-treat or refer for Stage II wounds

- Self-treat if 1-2% of body and superficial

- Refer to ED if deep-partial thickness burns

Description of stage III wound

- Full-thickness burns and deep lacerations and punctures

- May involve subcutaneous tissue

Examples of Stage III and Stage IV wounds

Animal or human bite, puncture wounds, severe burns

Time to heal for stage III and stage IV wounds

Lengthy recovery

Pain level of stage III wounds

- Painful (deep punctures/lacerations)

- Painless (from intense heat exposure)

Self-treat or refer for Stage III or Stage IV wounds

Refer for emergency treatment

Exclusion for burns: BSA of _____________ or more if superficial partial-thickness or deeper injury

2%

Exclusion for burns: Burns (other than sunburn) involving ______________

Eyes, ears, face, hands, feet, or perineum

Exclusion for burns: These types of burns

- Chemical burns (first aid then medical attention)

- Electrical or inhalation burns

Exclusion for burns: Age

Age > 65

Children (other than for stage 1 sunburn)

Exclusion for burns: Medical conditions

Diabetes or 5 or more chronic disease states, immunocompromised

Exclusion for wounds: Involvement of these body parts

Face, mucous membrane, or genitalia

Exclusion for wounds: Medical conditions such as

Immunocompromised patients and diabetic patients

Other exclusion criteria for wounds

- Wounds containing foreign matter after irrigation

- Chronic wound

- Wound secondary to an animal or human bite

- Signs of infection

- Deep, acute wound

Exclusion criteria for sunburns

- Large area of blistering

- Fever

- Extreme pain

- Headache or confusion

- Lightheadedness or vision change

- Severe swelling

- Signs of infection (area of redness or red streaks spreading or moving away from open blisters; open blisters that are draining pus)

BSA of front/back of head

4.5% each

BSA of front/back of each arm

4.5% each

BSA of front/back of leg

9% each

BSA of chest/back

18% each

BSA of genitalia

1%

Between which times should you limit sun exposure?

10 AM - 4 PM

Other methods to avoid/minimize sub exposure

- Avoid exposure to the sun and UVR from other sources

- Wear protective clothing including tightly woven fabrics to block sun

- Use beach umbrella to block sun

- Consider time in water as part of total time in sun (water and wet clothing allow significant transmission of UVR)

Use sunscreen with SPF of _______ or greater

15

Maximum SPF of sunscreen before there is no more protection

50

When should you apply the first dose of sunscreen>

15 minutes before exposure

How much sunscreen should you apply over exposed area?

1 ounce (avoid eyes)

How often should you reapply suncreen?

Depends on the product (usually every 40-80 minutes)

Other sunscreen recommendations

- Use a broad-spectrum sunscreen (zinc oxide and titanium dioxide)

- Use water-resistant sunscreen if you will be in the water

- Check expiration date

- Wear sunglasses and sunscreen if on snow or sand (reflect UVR)

Approach to treatment of burn with unknown cause

- Check med history for possible photosensitization

- Refer to dermatologist

Approach to treatment of burn that occurred in the past 20 minutes

Immerse affected area in cool, tap water for 10-30 minutes or apply other appropriate first aid measures

Approach to treatment of pain associated with burn

Aspirin, NSAID, or APAP

Approach to treatment of dry burn area

Skin protectant ointment/absorbent dressing

Approach to treatment of wet burn area

- Soak affected area in cool tap water 3-6 times a day for 15-30 minutes

- Apply skin protectant cream/absorbent dressing

How often is a tetanus dose required after completion of basic series?

Every 10 years

Approach to treatment of wound with foreign/particulate matter

Cleanse wound with saline irrigation and cover with dressing, may use antiseptic

Approach to treatment of wound with no sign of infection

Cleanse wound with saline irrigation, apply antibiotic, and cover with dressing

What are gauzes used in?

Minor burns and wounds

Counseling points for gauze

- Available in many sizes and forms and can be used with topical products

- Must be held in place with second agent, fibers can adhere to wound bed, should be changed several times a day to prevent wound from drying out

Common uses of antimicrobial wound dressing

Wounds that are colonized or infected

Description of antimicrobial wound dressings

Contain products like silver and iodine that decrease bacterial load within wound bed

Description of specialty wound dressing

- Help maintain appropriate amount of moisture

- Absorbing moisture appropriate during inflammatory phase

- Maintaining moisture appropriate during proliferative phase

Examples of adhesive wound dressings

- Bandaids and Bandaid brand advanced healing strips and Liquoderm

Common uses of adhesive wound dressings

Superficial wounds (minor abrasions and lacerations)

Examples of systemic analgesics

NSAIDs, acetaminophen

Are NSAIDs or APAP preferred?

NSAIDs for anti-inflammatory activity

Prostaglandin inhibitor can decrease erythema and edema

When are NSAIDs recommended after exposure to UVR?

Within first 24 hours and effect is lessened after this time

Examples of skin protectants

- Allantoin

- Cocoa butter

- Petrolatum

- Shark liver oil

- White petrolatum

Should skin protectants be used on wet or dry areas?

Dry areas

How do skin protectants benefit patients with minor skin injuries?

Make the damaged area less painful by protecting against mechanical irritation

Examples of topical anesthetics

- Benzocaine

- Dibucaine

- Lidocaine

- Pramoxine HCl

Benefits of topical anesthetics

- Helps with pain but use in moderation

Dosing of topical anesthetics/antihistamines

- May use 3-4 times daily

- Relief only lasts 15-45 minutes

- Overuse can lead to hypersensitivity reaction and systemic toxicity

Do not apply topical anesthetics to more than ____________ % of BSA

1-2%

Use ___________ concentrations of topical anesthetics when skin is intact

higher

Use ____________ concentrations of topical anesthetics when skin is not intact

lower